Ask an expert - muscles and bones - feet

13 questions

A:There is no evidence that we can find, at least not in English, that acupuncture has been successfully used to treat bunion pain. There may well be papers amongst the many thousands published in Chinese each year, but none have as yet been translated. Working on the premise that important papers often make it into English you could probably assume that this means that there are no landmark studies.

From a western perspective once a bunion, always a bunion, unless you have an operation. The thickened skin and additional bone growth are not likely to be dealt with by anything short of surgery, and the best that is usually offered is anti-inflammatory medication to reduce the secondary inflammation and management advice - wider shoes, forms of cushioning.

There is a long and well-researched tradition in Chinese medicine of the use of acupuncture to deal with chronic pain, and the question in this case is simply how much pain relief treatment may provide and how sustainable it is. If treatment offered relief for a week or so, then it may be a worthwhile continuing programme, but it would not be realistic to look for anything beyond temporary relief alongside conservative management strategies like better footwear and padding.

There may be some merit in talking to a BAcC member local to you who can give you advice on the unique presentation of your problem, but as a general rule we would have to say that the chances of radical change in an area which it is difficult not to irritate in daily life are relatively small.

and if you google 'acupuncture' and 'plantar fasciitis' you will find a number of other papers which suggest that there may be benefits from treatment. However, the combined weight of the various studies is not enough to be able to give an unqualified recommendation.

That said, the strength of Chinese medicine is that it operates from an entirely different paradigm or theoretical basis, and has different ways of making sense of the symptoms which a patient is experiencing. This can sometimes offer treatment options which would not necessarily translate into a western understanding of physiology, although there is usually an overlap. The system of medicine rests on a theory of energy, called 'qi', whose flow and balance determine how well the various systems of the body function. Many problems like plantar fasciitis point to local blockages and disturbances, often due to over-use or poor gait, which once they have become established remain a problem even after someone's habits have changed. Symptoms such as this can also point to more systemic problems, and the skill of the practitioner lies in making a clear diagnosis of the whole system before starting to correct aspects of it.

In this case, since the presentations of plantar fasciitis can be very different, we would advise you to visit a BAcC member local to you for a brief face to face assessment of the problem before committing to treatment. We are fairly sure that you will have seen a chiropodist as well as your GP, but if you have not, we would highly recommend that you do. There are a number of treatment options which can work alongside acupuncture treatment to great effect, and with these sorts of problems it is often a combined approach which pays the greatest dividends.

We use the word 'encouraging' because the researchers used a protocol for gathering data which was partly devised by acupuncturists themselves within the framework often used to gather material, and the results reflect far more accurately than usual the probable benefits of acupuncture.

However, all reviews of this kind will conclude that more and better studies are needed. This is just a reflection of the fact that while acupuncture is regarded as a fringe actibity it will never attract the levels of funding which are required for studies of sufficient size, and we shall be continually reporting that there are encouraging but inconclusive signs!

We would really like to know a little more about how the condition which you have developed. This is quite often associated with exercising or jogging, and this impacts on the possible solutions. What we can say is thatwe would want to know what had been ruled out by conventional tests before we gave a professional view of whether we could help. There are some forms of damage in this area which would not be amenable to acupuncture treatment, and might only be corrected by surgery.

However, the majority of cases involve inflammation and tightening of the tendon, and from a Chinese medicine perspective this points either to local blockage and stagnation through over-use or accident, which might be amenable to local treatment, or a much more wide-ranging systemic condition of which this is the earliest manifestation. The skill and art of the practitioner is what enables them to determine the extent to which the problem is a reflection of a wider pattern of imbalance, and this in turn ensures that the treatment is not applied just locally as a quick fix which may not last that long.

The advice in all of these cases, where we lack the specifics of the problem and cannot make a face to face assessment is to visit a BAcC member local to you and see if they are happy to give up a short amount of time without charge to give you a more balanced view of what acupuncture treatment may be able to achieve. If they think there are other and more effective options, they are likely to say so.

A: There are a number of case studies, relatively small in terms of the numbers of participants, which seem to show positive and encouraging results for the use of acupuncture for foot drop after strokes. However, the evidence is by no means comprehensive or conclusive enough for us to give a positive recommendation for treatment.

However, a great deal depends on what else is going on in your system. Foot drop as an isolated symptom is unusual, and very often there is a more complex neurlogical picture within which this sits. If there isn't, then from a Chinese medicine perspective the weakness would be understood in terms of a blockage or weakness in the flow of energy, or 'qi' as it is called. The practitioner would probably use a combination of local and distal points to try to restore proper function in the tendons and muscles affected by or causing the condition.

If there is a wider pattern of dysfunction, however, then the chances are that this will bea a neurological problem whose treatment with acupuncture wouldm be less likely to be successful.

However, there is no substitute for a face to face assessment in cases like yours and we believe that it would be worthwhile visiting a BAcCc member local to you to benefit from their advice. If they feel that acupuncture will not be of use, we are confident that they may have other suggestions about what forms of treatment may be best for you.

Q: I have numbness in my feet (not 100%)which prevents me from falling asleep and is generally most uncomfortable. It is apparently not related to diabetes - according to medical tests - nor to a neurological condition. Can acupuncture help?

A: The short answer is that it is difficult to say! Had you gone to one of our members before seeking any other treatment they would have referred you back to your GP for tests for diabetes and for further neurological assessment. Given that both of these have been done and nothing has been found, the next question would be whether the condition developed slowly or whether it had a sudden onset. This might point to an injury or set of circumstances which might explain its occurrence.

In broad terms Chinese medicine is based on a theory of energy, called 'qi', the flow, balance and rhythms of which maintain the body, mind and spirit in healthy function. There are a number of internal and external causes which can disturb the flow, and also a number of constitutional factors which predispose people to certain types of symptom. The practitioner will cover a great deal of ground trying to understand the unique balance of each patient to find the most effective means to try to address the problems.

In the case of symptoms such as numbness, there are functional reasons why this can occur, and it is a recognised part of several syndromes. If this were the case the practitioner would expect to find other parts of the same pattern in someone's health, not necessarily as symptoms, but just as features of daily living which they have come to accept as 'normal', like bruising easily. There may be more localised reasons for the symptoms, although the fact that both feet are involved tends to suggest otherwise - an identical bilateral local blockage would be unusual.

There is such a wide range of possible interpretations based on diagnostic evidence which we do not have that realistically the only way you are likely to get an informed answer to whether acupuncture treatment will help would be to see a BAcC member local to you for face to face advice. It is the kind of condition which we often find ourselves treating when conventional explanations have yielded no answers, but not every condition is necessarily treatable by acupuncture, and a responsible practitioner will want to see how the problem manifests before committing you to treatment.